Roles of the Registered Nurse (RN) are ever changing where it is key to continue to educate for the protection and well being of the patient. Pressure ulcers have become a main issue in healthcare in an attempt to lower cost as well as prevent further morbidities and complications for the patient. According to the National Institute of Health (NIH) a pressure ulcer is defined as an area of skin that breaks down when something keeps rubbing or pressing against the skin. An increase in immobile and elderly patients has increased the risk for the development of pressure ulcers. The education and prevention of pressure ulcers should be implemented as a key goal for a nurse during the care of a patient. Pressure ulcers is tissue damage …show more content…
Shearing is when the patient is pulled against the bed while in a stationary position usually as a result of gravity. (Ignatavicius, 2013) Managing the incontinent patient is key in the prevention of pressure ulcers because moist skin is more vulnerable when the external mechanical force is applied. (Ignatavicius, 2013) A diligent nurse who pays attention to the risks and causes and implements a plan of care can avoid the development of most pressure ulcers. Assessment of a patient is key in preventing a pressure ulcer from occurring as well as keeping a pressure ulcer from getting progressively worse. A history of the debilitated patient can often determine the cause and risks. Some risk factors include bed rest/immobility, incontinence, diabetes mellitus, inadequate nutrition/hydration, and altered mental status. (Ignatavicius, 2013) Nurses must meticulously assess a patient history to determine the severity of developing an ulcer. The Braden Scale is a widely used tool for predicting a patient’s risk for developing a pressure ulcer. It uses 6 categories that include sensory perception, moisture, activity, mobility, nutrition, and friction and shear and rates the risk of 1-4 for each category. A patient with a score of <11 is at severe risk, 12-14 puts a patient at moderate risk, and a score >14 is at low risk. (Ignatavicius, 2013) When physically assessing a patient, the nurse must inspect the entire
Evidence suggests that pressure ulcers greatly increase mortality rates in both hospitals and nursing homes (Thomas, 2001). Patients who develop a pressure ulcer within six weeks of admission to an acute-care facility are three times more likely to die than patients who do not develop pressure ulcers (Thomas, 2001). Moreover, patients who develop a pressure ulcer within three months of admission to a long-term care facility are associated with a 92% mortality rate compared with a 4% mortality rate for patients who do not develop them (Thomas, 2001). This evidence alone shows how significant this problem is to the overall health status of patients. In my personal nursing experience, I have heard many complaints voiced from patients and their family members concerning the development of new pressure ulcers. Patients and family members have expressed dissatisfaction because of the increased stress and prolonged hospital stay often associated with the treatment of pressure ulcers.
The authors were concerned with health-related quality of life (HRQL) and how pressure ulcers impact the patient's subjective experience of care, because overall health care outcomes may be influenced by the interaction between disease burden and patient compliance. Thirty adult patients in hospital, rehabilitation, or community care in England and Ireland were recruited for the study. Inclusion in the study required being under the care of a tissue viability nurse.
Nursing interventions play an important part in the reduction of pressure ulcers. A nurse can help to reduce the risk of pressure ulcers by promoting activity, carrying out skin inspections and assessments, and by using pressure relieving devices (Lynn, 2005). Some patients may fear being dropped when moved using equipment (Rogers, 1999), thus it is important for the Nurse to communicate with the patient, this way the Nurse can explain how the equipment works and the patient can express any concerns that they may have. It is important to remember that not all patients like lifting equipment and
Although the situation was quite challenging, it provided me with some useful experiences for the future practice. I understand that all institutions should have a policy for documenting the assessment of patients, including pressure ulcers (Morison 2001). I have come to be familiar with the homes assessment policy using the Sterling Pressure Sore Severity Scale and most importantly I have learned that by using a universal assessment tool it supports a systemic and consistent approach to pressure ulcer evaluation. This therefore supporting continuity of care.
Fortunately, according to Chan et al., (2008), 95% of pressure ulcers can be prevented and nursing care is believed to be a primary method of preventing pressure ulcer development. Research was conducted on accredited search databases such as CINAHL, Nursing Resource Center and OvidSP on prevention measures for pressure ulcers. A number of credible evidence based research was found that supported the nursing intervention of
Nurses need to realise what they are looking for when performing skin assessments for patients. A study conducted by Thoroddsen et al (2013), found that out of 45 patients that had pressure ulcers only 27 were correctly recorded in the patient’s records.
Thus, the expected outcome is that there is prevention of skin breakdown relating to pressure ulcers during hospitalizations for patients.
The worse possible outcome of a pressure ulcer is death, with an approximation of 60,000 patients dying each year as a direct result of a pressure ulcer (Stotts & Gunningberg, 2007). This is significant to nursing practice because if we can prevent more pressure ulcers from occurring, we can dramatically improve patient outcomes, patient family and satisfaction, and even prevent the death of a loved one.
The main priority of the Veterans Affairs system is getting zero pressure ulcers. To achieve this goal, staff must be knowledgeable of the basic principles of skin disease, preventions, and treatments when providing care for the elderly patients. They provide education and training on the current evidenced-base practice on pressure ulcer preventions. The approach that has been effectively used is the care bundle (AHRQ, 2014). We
Braden scale (Braden & Makelburts, 2005) use in hospitals allows nurses to identify patients at risk for pressure ulcer based on their sensory perception, mobility, activity, moisture and nutrition. Although the Braden scale is a useful tool but healthcare administrations has yet found the best method to eliminate pressure ulcers or bedsore in intensive care units. The use of foam dressing will be introduced to the intensive
20). Further, the presence of pressure ulcers places a burden on patients and their family (Grinspun, 2005, p.21). As recommended by Grinspun (2005), pillows and foam wedges to separate prominences of the body and lifting devices have been beneficial to avoid friction (p. 32). Research suggests that the majority of pressure ulcers can be avoided. Although, the population at risk likely suffers from the possible contributors, as stated repositioning at least every 2 hours or sooner was effective (Grinspun, 2005, p. 32). When practicing I will reposition patients at appropriate times to reduce the risk of damage to the skin. Additionally, when moving a patient up in bed, I will request adequate assistance from other nursing staff to use a lifting device. This will help to avoid friction while the patient is being moved, ultimately reducing the development of pressure
The qualitative research article selected for critique is the study by Athlin et al. (2009), with the title of, “Factors of importance to the development of pressure ulcers in the care trajectory: perceptions of hospital and community care nurses”. This study looked at contributing factors promoting the growth or relapse of pressure ulcers, and how the nurses working in hospitals or group care, comprehend them in the care trajectory.
Pressure Ulcers affects patients the older patients due to the problem of immobility. A pressure
The INTACT trial showed a significant reduction in pressure ulcers (PU) incidence in the intervention group at the hospital (cluster) level, but this difference was not significant at the
Pressure ulcer is an adverse outcome in the clinical care setting that also linked to poor quality of nursing care. Though pressure should never happen in a professional care setting, it is still prevalent throughout the world’s medical settings. This article looks at many other previous studies from 1992 to present to compare and find the underlying issues that may contribute to pressure ulcer. A closer look at the nurse’s knowledge versus actual decision will be observe, because it is the key factor in pressure ulcer prevention.